Influência da renda familiar sobre os níveis séricos de hemoglobina em crianças de baixa renda após suplementação nutricional durante a pandemia do Covid-19

Abstract

Poverty is a health determinant that favors the installation of the immediate causes of anemia, as well as other forms of malnutrition, contributing to the high burden of nutritional problems found in low- and middle-income countries, especially in vulnerable groups. At the same time, family income influences children's nutritional and mental health. Thus, the aim of this dissertation was to evaluate the influence of family income on the effectiveness of a nutritional supplement formulated and commercially available, containing macronutrients and multiple micronutrients, on the serum levels of hemoglobin in low-income children, aged between one and six years. and residents in a subnormal cluster located in the Brazilian capital Maceió-AL. This is a quasi-experimental, single-arm, before-and-after clinical trial. The intervention consisted of the use of a food supplement, daily for 120 days, associated with vitamin A megadose, therapeutic iron supplementation and treatment against parasites. A standardized questionnaire was applied to collect the variables of interest, the Brazilian Food Insecurity Scale (EBIA), anthropometric assessments in children and mothers, and capillary hemoglobin was measured in children. Pearson's chi-square test was applied to analyze the associations between categorical variables and the McNemar test to assess differences between prevalences. The generalized estimation equation model was used to test the effectiveness of supplementation and the Bonferroni correction to assess the effect of family income and length of follow-up on the outcome. 383 children were evaluated and an initial prevalence of anemia of 40.5% was verified, which in the end was reduced to 15.5%. In the Bonferroni post-hoc correction, it was observed that only children from families with no monthly family income did not show a significant increase in hemoglobin (p <0.09). We conclude that monthly family income influences and, therefore, can modify the expected effect of macro and micronutrient 7 supplementation on serum hemoglobin levels in children under six years of age, indicating that children in extreme poverty may benefit less from nutritional interventions.